“Let me take a look.” Nora knelt at the end of the bed. As Mrs. Franklin had said, this birth was well underway. And breech. Instead of a bit of scalp, she caught a glimpse of baby buttocks crowded against Betsy’s opening—still small, which was a concern. Nora had no idea how long Betsy had been laboring, but big babies and little pelvises always flooded her with dread.
“Blood loss?” Nora asked as she unbuttoned her sleeves.
Mrs. Franklin jerked her head. “No. But poor Betsy’s worn out. This is her first. I usually wait for the babe to make his own way through, but we’ve been here for hours.”
A moan mounted, ending in a scream that tore at Nora’s chest. Patients coped with pain differently, but as Nora addedup factors—breech presentation, primigravida, unproductive labor, maternal exhaustion…
“It’s good that you sent for me.” She glanced at the vaporizer, then turned back to the patient. “Betsy?”
No response. She was too lost in her suffering to register anything.
Mrs. Franklin gripped Nora’s arm and angled her away from the bed. “Betsy’s my niece. My sister died three weeks after giving birth to her.” Her jaw clenched, and Nora noticed her drenched collar and glistening neck. “I can’t let it happen again.”
Nora scrutinized the scene with new eyes. Everything changed when family was attending. The baby’s buttocks inched forward with a contraction, then slid back again. At least the child was prone—face to the tail, as the midwives said. “It’s not the worst position,” Nora reassured Mrs. Franklin. “We’ll take care of Betsy together.”
Nora yanked out her jars of wine and olive oil and threw some of the oil over her hands just as Magdalena had taught her.
Never force your hand into delicate tissue. You must be as slippery as the child itself. And for the sake of everything holy, keep your nails short.Slow down and think!
Betsy screamed again and the buttocks slid forward, far enough that Nora could see the hip joints.
“That’s progress,” Mrs. Franklin cried.
Nora was about to lower into a better position, but Mrs. Franklin was already there, weathered hands poised and a mask of fierce concentration on her face. “Bear down, now, Betsy. It’sa boy. We’re almost through it.”
“You continue,” Nora said, shifting sideways. “I’m here if you need me.”
For all her earlier anxiety, Mrs. Franklin was confident now. Nora understood the sudden change. Frequently, an oncoming crisis simply forced uncertainties to vanish, compelling you to succeed. And sometimes that swift, blind courage worked, but it was hell when it didn’t. So as Nora leaned back, crouching on her heels, she watched carefully.
Betsy groaned and panted as the baby’s body slowly emerged, his legs pinned up, unable to fall loose. Betsy’s thighs shook with pain and pressure, and Nora longed to pull the child out and make the suffering stop, but birth required faith and restraint. The progression stopped, and Nora and Mrs. Franklin leaned in closer. The tiny feet had wedged behind the vulva like bolts in a lock, impeding further descent. Nora started to reach forward when, with practiced movements, Mrs. Franklin hooked her fingers behind the baby’s knee joints and flexed upward, freeing the feet to pop out and dangle as she held up the child’s belly.
Nora smiled. Most doctors would have tried to stretch the opening laterally, but someone had taught Mrs. Franklin this gravity-assisted technique—one Nora had seen only in Italy. Nora spared a glance at Betsy’s purple face, swollen from hours of exertion, her eyes tormented slits.
“Nearly there,” she said, reaching up to press the mother’s tightly clenched fist.
The baby’s back slid into view, tilting to take advantage of every sliver of open space. Screaming, Betsy grabbed herbedcovers, so Nora jumped to her side, rubbing Betsy’s upper arms and shoulders with hard, grinding strokes as the nuns had taught her.
“I’m going to die like my mother,” Betsy sobbed.
“You’ll do no such thing,” Nora promised as she tried to massage some courage into her. She glanced at Mrs. Franklin, who hadn’t responded to her niece’s cry.
“What?” Nora asked. Something else was wrong.
“One arm is pinned up by the head. I’ve seen breeches like that where the child was palsied all their life.”
Nora nodded. Nerve damage at the neck and shoulder could be crippling. “Let me look.”
The vaginal wall quivered. There wasn’t a centimeter left, no give for the bulging weight of the baby. “I need to cut.” Nora spoke softly, only for Mrs. Franklin’s ears. “Can you get the surgical scissors from my bag?”
Nora didn’t hold with cutting, though many doctors favored the procedure—which they called episiotomy.
Mrs. Franklin answered with a grim frown. “You need to hurry.” She knew, better than Nora, that delay was dangerous.
“I assume these are the ones you want?” Mrs. Franklin passed Nora the blunt-edged scissors. A quick nod—they were the right ones for this, though not specifically what she’d requested. This midwife had good instincts.
Nora exhaled. She liked to have a little more time to select her spot, but this would have to do.
She closed the blades and Betsy jerked, letting out a piercing scream. “Sorry,” Nora whispered through grinding teeth. Blood ran from the wound as Nora inserted her hand, working herfingers carefully between the baby’s sternum and Betsy’s pelvis, the contractions crushing her hand painfully. She waited as the pain mounted, her fingertips numbed from the pressure. She could just brush the baby’s chin, but not yet reach his mouth.
